Month: April 2017

We work in a vulnerable profession. The people we work with are considered part of the “vulnerable populations”, and through working and living with them they teach us how to become vulnerable. Through our caring for them we start to break down our own walls and open ourselves up to growth, change and learning about ourselves and others. As with any relationship, we form attachments. These relationships are symbiotic, and very rarely do we recognize this. We see ourselves as a sort of essential component in their lives without recognizing the overwhelming impact they have on ours. Our lives become shared experiences –they are very much a part of our lives as we are a part of theirs. I think it isn’t until we face the challenge of living without these people do we realize just how much of an impact they have made.

The people we work with teach us how to communicate, how to express our feelings, and how to foster and maintain relationships. Typically this occurs in such an atypical fashion that we fail to recognize it as a learning experience, or an opportunity for growth. In my experience working in this profession our learning occurs in a very nuanced and subtle way.

First, let me begin by introducing you to one client in particular who had a significant impact on my life. Let us call him “Barry”. Barry is a middle aged man with an intellectual disability on the Autism Spectrum Disorder. He uses cryptic language to communicate, talks through his stuffed bears, and exhibits typical symptoms found on the DSM scale for Autism. Typical interventions used are visual stories, following a set schedule, and providing Barry with different options to choose from. Typical of ASD is a stunted ability to express emotions, which we can see when Barry becomes frustrated or upset and is unable to share with those around him, either through body language or words, how he is feeling. This can be frustrating for someone who uses typical modes of communication, and quite often, things get lost in translation. In these situations you need to stop and ask yourself how frustrating would it be to know how you’re feeling, but be unable to share that with another person so that they too understand how you’re feeling? That must be hard. You then have to ask yourself, how can I express empathy and understanding, without being able to understand fully? Carl Rogers shows us how important and essential empathy is in any relationship (Rogers, C., 1951;1961). The ability to understand another person’s soul. The ability to understand the pain, joy, anger, frustration they are experiencing is one of the most intimate and connecting abilities we as humans have. When we emote with another person and they are able to express their complete understanding and acceptance of that we feel a new sort of connection with them, we feel seen and understood. Empathy fosters connectivity and a deeper level of intimacy with others, and it opens doors for stronger communication and relationships. Erich Fromm details the eight basic human needs, one of which is relatedness (Fromm, E., 1941; 1997).Relatedness can be achieved through the relationships we form, sharing our innermost feelings with others, and having them understand those feelings through empathic understanding. Now imagine being a person who has an inability to connect in such a way, a block of some sort which makes it difficult, sometimes what may feel near impossible, to connect with another person in such a way. How would you feel? Perhaps lost, disconnected, frustrated, angry, irritated? The list could go on. What are we to do? Are we to alter our communication, tailor our interactions with this man and others like him?

The reality is that those living with ASD are no less able of communicating, emoting, or experiencing fulfilling empathic relationships, it just takes a bit longer, and it may display itself in a different way. If relatedness is a basic human need, even those with alternative ways of communicating or emoting, will find a way to fulfill that basic human need. What has Barry taught me then? Barry has taught me that we communicate in different ways and the only way we will be able to understand each other is if we are open to and willing to understand each other, even if that involves extra work. With most of our relationships communication comes much more easily, we speak the same language, we express similar emotions to the same triggers, we become comfortable while around each other. This makes us lazy. We are so keen to believe we understand each other we fail to try. Barry shows us to listen to the silence, to attend to the potentially cryptic language, to ask the right questions and to make room for each other. Sometimes in relationships one person takes up more space and that’s okay. In our laziness we fail to see how hard others may be trying. We need to recognize how easy it is for us to emote and connect with others, and how potentially scary it may be for someone like Barry to do the same. This teaches us to be more understanding, patient, and open to forming relationships and perhaps helping others form the same relationships. We don’t all speak the same language, and we’d certainly be boring as a species if we did.

We are so wont to believe that they need us just to live and in the process we other them, believing that without us as their support they would fail to survive. This is the furthest thing from the truth.

Aside from teaching me how to communicate and how to listen, Barry also showed me what it means to be in relation with another person. He showed me how difficult it may be at times, and how two completely different people can develop and foster a meaningful relationship through mutual understanding, trust, and awareness of the other. Although difficult at times, potentially extra-strenuous, the relationship which I built with Barry showed me just how important the qualities listed above (trust, understanding, awareness) are in building a relationship with another person. A quality I did not list but which is equally as important is acceptance.Rogers presents unconditional positive regard as an essential component in a therapeutic relationship (Rogers, C., 1951; 1961) and there is nowhere in my life I have been able to experience this quality more than in my relationship with Barry. In fact, he showed me just what it looks like.

Regardless of what I wore, how I acted, or how I was feeling, he continued to accept me as I was, and continued to acknowledge me as an autonomous person. This may not have happened instantaneously, in fact, there were times where he needed to process why I wasn’t wearing jeans when he asked me to, or why I was upset with something he said to me – but after this period of processing, he would be able to look at me and see me for who I was, and still accept me as my self. This was one of the most powerful experiences I had while living and working with Barry.

As I reflect upon what I have learned from the people I have met and worked with, I come to think very fondly of the intimate moments I shared with the persons I was charged with caring for. Care-work is much more than a profession, it seeps into every facet of your life, and what you learn while working with others stays with you once you’ve severed ties. Throughout my time in this profession I learned not only how to care for others and come to understand the myriad of ways in which we as humans can care for and express our care for others; I learned how to care for myself. Care-work and self-care are inextricably intertwined, and I’ve touched on this before – the importance of caring for yourself and replenishing your energies so that you do not experience burnout. Even outside of care-work however, it is an important take-away: make time for yourself. I will not outline here the endless ways in which you can practice self-care because that would be an interminable digression. The important thing to remember is that care-work teaches you how to handle yourself in a much more understanding, forgiving fashion: and this attitude extrapolates to all other relationships you currently have or are in the process of building.

The next client I would like to discuss is someone who has taught me a number of things including self-acceptance, self-awareness and forgiveness. Let us call her “Rosie”.

Rosie is a senior living with schizoaffective disorder bi-polar type, with observed OCD like behaviours, anxiety and substance over-use/dependency. She spends a significant portion of her time in quiet contemplation and solitude. At times she will scream or yell, shout obscenities or appear to be talking to herself. In these moments it is important to understand who the vocalizations are directed at: are they directed at others, herself, or perhaps her hallucinations? This conundrum eludedme sometimes, but I tried my best to give her her space. In instances where she would exhibit increasing anxiety while vocalizing, it was important to assess whether this anxiety came from my failing to communicate with her, or if it stemmed from an internalized mental experience.

When Rosie exhibits anxiety it may very quickly escalate into self-harmful behaviour. This self-harm is a way to regain power and control, or could very well be a response to a persecutory hallucination. Even though we do not know the reasons behind it,this self-injurious behaviour serves a purpose. Although we do not want Rosie to injure herself, we are unable to control for it at times and the best thing to do is to try to understand her as a person, instead of trying to keep her from injuring herself. Again, here we return to Rogers’ idea of empathic understanding, and unconditional positive regard. The best way to get to know someone, to truly see into their soul and express back to them your complete understanding of them, is to express and practice empathy with them. This becomes difficult with someone like Rosie, who has only ever experienced understanding as controlling. Controlling for anxiety, behavioural issues, injurious behaviour, violent tendencies and so forth. Perhaps the behaviours we fail to understand are her way of trying to communicate and instead of listening and being receptive to this we control the behaviour because it is atypical, therefore wrong. This is how Rosie taught me about self-awareness.

I very quickly became more aware of the things I said, the way I acted, even things as simple as my body language, tone, and facial expressions. Sometimes the way we communicate with each other can misconstrue the things that we are saying. Our tone, body language and facial expressions are saying one thing while our words are saying another. This can cause confusion, and makes it more difficult for trust to flourish. Trust is a fundamental component of any healthy relationship, without trust as our foundation we cannot build a solid relationship. This awareness did not end with myself, I became more aware of others non-verbal communication patterns and was more receptive to deeper meanings. This also led to a greater understanding of the way others communicate and the possibility for their not being alternative meanings. Perhaps, there are other explanations for why the tone did not match the message being shared. Rosie taught me to read into things when needed, and to recognize things at face value when needed.

Along with her lesson in self-awareness she taught me forgiveness and self-acceptance. Forgiveness because we all make mistakes, and she was quick to apologize when needed: sometimes she apologized when there was no need to. Her apologies came quickly, and sometimes she didn’t understand why she was saying she was sorry. I’m sure this stems from something in her past that makes it so easy for her to apologize, sometimes needlessly. The important thing she taught me was that sometimes, even when we don’t know why we’re apologizing, we need to do it anyway. This is because the person we have hurt needs to hear it said – there is always a reason we apologize (to mend broken hearts, hurt feelings and relationships) but sometimes we aren’t always completely aware of why. It isn’t until after the fact do we understand why the apology was needed. Being stubborn about apologizing only increases hurt feelings, making it more difficult to rectify the situation. On the other side of the argument, forgiving someone can be just as hard as apologizing. It’s a matter of pride: Rosie taught me pride means nothing when it comes to mending hurt feelings. Pride merely gets in the way, and relationships are much more important than personal pride. Admitting your faults is a sign of strength.

The last thing Rosie taught me was self-acceptance. Akin to how Barry taught me what unconditional positive regard looks like, Rosie taught me what real self-acceptance looks like. She struggled with body-image issues, and the majority of the time was quite distressed over her weight and the size of her stomach. She would compare herself to others around her wondering why they were so skinny and she wasn’t. Sometimes she would say things that made it clear her desire to be skinny was heavily influenced by those in her life who had told her before how important it was to lose weight and get smaller. There were times of quiet where I’m not sure if she had actually started to think of something else, or if she was sitting ruminating on these negative perceptions of herself. When she didn’t vocalize these feelings, I merely assumed she had forgotten about the issue, but I have a feeling these thoughts remained with her in the back of her mind permeating through every day, and every activity. There were times when she would become increasingly anxious and would vocalize an issue with her stomach or weight. This leads me to believe she was in fact ruminating on these perceptions, and for the most part these fuelled her anxiety. The amount of distress she experienced over something as seemingly insignificant as her weight caused tension in all other areas of her life. I can’t conclude with any authority that Rosie has accepted herself, or that there have been any significant changes in her mindset. She did not lead by example. However, watching Rosie become increasingly distressed over her weight encouraged me to practice self-love and acceptance. She showed me how important it is to accept yourself, be forgiving of your faults and shortcomings, and change what it is about yourself you don’t like.

Just like Barry, Rosie projected acceptance and love more so on others than on herself. In these moments, the importance of self-acceptance was reinforced.

We consider ourselves as care-workers to be the leaders, the teachers, the guides, when in all reality it is our clients who are teaching, leading and guiding us. They open our eyes and minds to a plethora of experiences we would not be open to experiencing if not for them. They also provide us with different ways of seeing and understanding things. There is nowhere in my life where the sentiment of different intelligence’s is more obvious than in care-work. Not only are you exposed to these different forms of intelligence, you are exposed to varying presentations of these intelligence’s. Each new day is a marvel, learning how others see and make sense of the world around them, and coming to the realization that you, sadly, are missing a large percent of the world and its happenings because you are stuck in the monotony of typical modes of intelligence. Your being stuck in these modes not only limits your ability and willingness to see the world from a different perspective, it blocks you from experiencing life to your fullest ability.

I have learned a great many things in this profession, particularly that care-work can be stressful, frightening, and challenging. At times these challenges may overwhelm us, leaving us feeling drained and empty. When we step back and reflect on our experiences we are able to see the work we’ve done has made a difference, but our work is just the beginning. Our care-work is much more a self-reflective experience than it is a mode of treatment or assistance for others. Through this self-reflection, and of course our close work with our clients, we form meaningful attachments. These attachments strengthen our sense of self, and bolster our understanding of the world around us. When we sever these ties we feel the aftershocks of detachment. If there is one thing I can take away from these experiences with any confidence it is that there is nothing more challenging, frightening or stressful than saying goodbye.

Fromm, Erich. (1997). On Being Human. London: The Continuum International Publishing Group Ltd.